UWM Civic Engagement Reporting Form

The purpose of this form is to provide campus departments, faculty, staff, and researchers the opportunity to report civic engagement activities done throughout campus. This information will be used to highlight the good work done by individuals and departments that drive the civic mission of our campus. Please fill out this quick form to report activities such as community-based research efforts, student engagement in community-based learning with the non-profit sector, department sponsored community service (such as blood drives or food drives), or other civic-minded efforts. Unsure if whether an effort qualifies? Just let us know about it, it probably does. If you are still not sure, then email Laurie Marks at lmarks@uwm.edu.

Name:

Email:

Phone number:

Please include area code.

Sponsoring (or co-sponsoring) departments:

Community partners involved:

Please give agency/organization name as well as a contact person.

External funding:

Yes—external funding secured.

No—no external funding secured.

External funding details:

If you answered yes to the previous question, from whom was the funding secured?

Categorie(s):

Community-based research

Community-based learning

Community service

Other (explain below)

Check all that are applicable.

Other:

If you checked Other above, please explain.

Description and goals of the work:

Publications:

Yes

No

Has this effort resulted in any publications? If so, please give citation below so they can be highlighted on the Community Engaged Scholars Network (CESN) "Gallery of Public Engagement" page.

Publication citations:

Duration of the partnership:

Campus support:

Describe any ways in which you feel the campus could further support your campus-community partnerships or civic engagement work.

Other information:

Provide any further information you would like included in the gallery about this effort.